Active NPI
Jennifer Kathleen Connor-Smith, PHD
- Clinical Child & Adolescent Psychologist
- Portland, OR
National Provider Identifier
1699077966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 1496
- Practice address
- 5331 SW Macadam Ave
Suite 363
Portland, OR 97239-6104 - Phone
- (971) 338-3481
- Fax
- (971) 285-4510
- NPI assigned
- Nov 18, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 1496 | OR | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1496 | OR | Primary |
Addresses
Primary practice location
5331 SW Macadam Ave
Suite 363
Portland, OR 97239-6104
Mailing address
5331 SW Macadam Ave
Suite 363
Portland, OR 97239-6104
Phone (971) 338-3481
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1496 | OR | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290038400000",
"number": "1699077966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5331 SW MACADAM AVE",
"address_2": "SUITE 363",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972396104",
"telephone_number": "971-338-3481",
"fax_number": "971-285-4510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5331 SW MACADAM AVE",
"address_2": "SUITE 363",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972396104",
"telephone_number": "971-338-3481",
"fax_number": "971-285-4510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOR-SMITH",
"first_name": "JENNIFER",
"middle_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-18",
"last_updated": "2010-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "OR",
"license": "1496",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "1496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.